I swear sometimes that I got through our whole NICU experience on naivety, hope and faith/trust. Not knowing a much about the preemie world and very little about the medical world, you have to trust in the experts taking care of your baby. A lot of the things they did seemed crazy but you had to have faith that they knew what they were doing. Later on as we learned from our experiences I could speak up with my more educated opinion when I felt strongly about something either from observation or from the mama instinct.
So where is this going? Well I figured out today that I have still been pretty ignorant in the area of Xander’s size/weight. I was on an IUGR preemie forum a couple of months ago and the moms were complaining about people always exclaiming how small their child is. I had never thought of it being because of his IUGR status, I always just said oh he’s a preemie. But that forum got me thinking, and I know you aren’t supposed to compare your kids with other people’s kids, but I’d be interested to see how Xander looks next to a FT baby of his gestational age. What is IUGR? intrauterine Growth Restriction. In our case, the placenta embedded itself over a 8cm (~3inch) fibroid/mass in my uterus. They were both competing for blood and the placenta was not able to get the typical amount of blood/nutrients a baby needs to grow, so Xander ended up being on the small side. He was the size of a 23 weeker instead of a 28 weeker. Luckily that didn’t stop his development, just his size.
It was just a curiosity until yesterday at his last RSV shot of this season/10.5 month wellness checkup. Xander weighed in at 15lb. 6oz. Up 9 oz from almost 4 weeks ago. They always give you the charts with a curve on it showing his previous weights and how they are on an upward curve meaning he is growing and usually they seem satisfied so I am satisfied that they think everything is ok. Again that trust that they know what is going on and when something might be wrong. The pediatrician didn’t seem quite as impressed this time with his chart. It was a gain, so that is good, but I think his curve may have dropped off a little. So I took a look at his growth chart today.
He is on a growth chart that says: Low Birth Weight Premature Boys, Weight-for-age percentile (Boys, 1500 to 2500g). This is a step up from the Very Low Birth Weight chart he used to be on. What I hadn’t realized in the past is that this chart goes by his gestational age, the adjusted age, the age he would be if he was born on his due date. Facepalm. I always knew it said he was in the 0th percentile for age, but on this adjusted chart for his “Gestation-Adjusted age” he is maybe in the 10th percentile. So compared to other PREEMIES with his gestational age he is small so to other FT babies of his gestational age he is tiny.
Notice that it starts at -2 months of age!
It hasn’t concerned me before, I love his adorable petitness, but I do worry about his growth and weight gain with the pediatrician making notes of what he is eating. He has never been a huge eater and everything is still fortified (we add a little formula to the BM) to 22 cal. (regular BM is only 20 cal). On a good day if he eats everything, he gets just over 21 oz. We can only get him to eat so much, sometimes he refuses to eat after only 1/2 a bottle, sometimes we can distract him and get him to eat more, but usually when he is done, he is done. He likes baby food, green beans and sweet potatoes are his favorite. But as the Ped said, there aren’t a whole lot of calories in the solids. He doesn’t like puffs or yogurt melts or anything hard/dry. He gags on that stuff and pukes up whatever he might have eaten before trying those. The pediatrician told me to try soft finger foods, like avocado or baby food that is chunks in liquid to see if he will eat that. Maybe it is a sensory issue, who knows right now.
So what if his growth drops off even more, does he go into the failure to thrive category? Everything else seems fine, he is hitting his milestones, at daycare they are impressed at what he does as he is still so little. He will be getting teeth shortly, they are ready to burst through, he is just a mighty little man in a tiny package. I guess I have a complex also about him still being in 3-6month clothes at 10 months/7 months adjusted. He is fairly close to moving up to 6-9 but some of the 3-6 still have room. Also I had a dentist appointment today in my hometown and a high school classmate of mine is the receptionist there now. She was pregnant at my last appointment so I asked her how the baby was. He is 5 months old and doing well, she asked how my baby is and I said Xander is doing well, he’s 15lb 6 oz… I think I mentioned he was early and she said her 5 month old is bigger, weighs more than my 10 month old. She didn’t say how much he weighs but it was a little disheartening.
Knowing where he is on the ADJUSTED chart makes the times he refuses to eat the rest of his bottle, or pukes up his bottle/food even more frustrating when you know every bit we can get in his mouth counts towards his growth.
We are just doing our best to keep Xander healthy and growing, but it is harder when you know things that make you tend to worry more or be more dramatic about something that you shouldn’t stress about if you are doing the best you can.